A Telegram-based behavioral intervention for smoking cessation after myocardial infarction: study protocol of a pragmatic, single-blind, randomized trial

Smoking cessation after myocardial infarction (MI) is critical, yet many patients relapse soon after discharge, especially where structured follow-up is limited. Telegram provides a low-cost tool for implementing chatbot-based behavioral support that hospitals can run with minimal technical resources. The aim is to conduct TELEGRAM-MI trial tests to ascertain whether a 6 month Telegram-based chatbot improves cessation outcomes compared with routine discharge advice provided by cardiology staff. This pragmatic, single-blind, randomized trial, starting in 2026 at a regional clinical hospital in Russia, will enroll adult current cigarette smokers hospitalized with acute MI who use Telegram. Participants are randomized 1 : 1 to routine discharge advice plus a passive bot (control) or to the same advice plus an active 6 month behavioral support bot. The intervention includes motivational messages, craving-management tools, an SOS function, weekly check-ins, and relapse-prevention sequences. The primary outcome is 30 day point prevalence abstinence at 6 months, verified by a blinded assessor and a relative. Secondary outcomes include 7 day abstinence at 1 and 3 months, changes in cigarettes/day, nicotine dependence, motivation, engagement, and time to relapse. Analysis will follow intention-to-treat principles. Recruitment begins in January 2026. Results are expected after completion of the 6 month follow-up in October 2026. The intervention could enhance cessation, sustain recovery after MI, and offer a practical way to extend secondary prevention beyond the hospital site.